Dissociative fugue

Photo by: Brian Jackson

Definition

Dissociative fugue is a rare condition in which a person suddenly, without planning or warning, travels far from home or work and leaves behind a past life. Patients show signs of amnesia and have no conscious understanding or knowledge of the reason for the flight. The condition is usually associated with severe stress or trauma. Because persons cannot remember all or part of their past, at some point they become confused about their identity and the situations in which they find themselves. In rare cases, they may take on new identities. The American Psychiatric Association (APA) classifies disassociative fugue as one of four dissociative disorders, along with dissociative amnesia , dissociative identity disorder , and depersonalization disorder .

Description

The key feature of dissociative fugue is "sudden, unexpected travel away from home or one's customary place of daily activities, with inability to recall some or all of one's past," according to the APA. The travels associated with the condition can last for a few hours or as long as several months. Some individuals have traveled thousands of miles from home while in a state of dissociative fugue. (The word fugue stems from the Latin word for flight— fugere .) At first, a person experiencing the condition may appear completely normal. With time, however, confusion appears. This confusion may result from the realization that the person can not remember the past. Victims may suddenly realize that they do not belong where they find themselves.

During an episode of dissociative fugue, a person may take on a new identity, complete with a new name and even establish a new home and ties to their his/her community. More often, however, the victim realizes something is wrong not long after fleeing—in a matter of hours or days. In such cases, the victim may phone home for help, or come to the attention of police after becoming distressed at finding himself/herself unexplainably in unfamiliar surroundings.

Dissociative fugue is distinct from Dissociative Identity disorder (DID). In cases of DID, which previously was called Multiple Personality Disorder (MPD), a person loses memory of events that take place when one of several distinct identities takes control of the person. If a person with dissociative fugue assumes a new identity, it does not co-exist with other identities, as is typical of DID. Repeated instances of apparent dissociative fugue are more likely a symptom of DID, not true dissociative fugue.

Causes and symptoms

Causes

Episodes of dissociative fugue are often associated with very stressful events. Traumatic experiences such a war, or natural disasters, seem to increase the incidence of the disorder. Other, more personal types of stress might also lead to the unplanned travel and amnesia characteristic of dissociative fugue. The shocking death of a loved one or seemingly unbearable pressures at work or home, for example, might cause some people to run away for brief periods and blank out their pasts.

Symptoms

A person in the midst of a dissociative fugue episode may appear to have no psychiatric symptoms at all or to be only slightly confused. Therefore, for a time, it may be very difficult to spot someone experiencing a fugue. After a while, however, the patient shows significant signs of confusion or distress because he or she cannot remember recent events, or realizes a complete sense of identity is missing. This amnesia is a characteristic symptom of the disorder.

Demographics

Dissociative fugue is a rare disorder estimated to affect just 0.2% of the population, nearly all of them adults. More people may experience dissociative fugue, however, during or in the aftermath of serious accidents, wars, natural disasters, or other highly traumatic or stressful events.

Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders , 4th Edition, Text Revision, also known as the DSM-IV-TR lists four criteria for diagnosing dissociative fugue:

Unexplained and unexpected travel from a person's usual place of living and working along with partial or complete amnesia.
Uncertainty and confusion about one's identity, or in rare instances, the adoption of a new identity.
The flight and amnesia that characterize the fugue are not related exclusively to DID, nor is it the result of substance abuse or a physical illness.
An episode must result in distress or impairment severe enough to interfere with the ability of the patient to function in social, work or home settings.

Accurate diagnosis typically must wait until the fugue is over and the person has sought help or has been brought to the attention of mental health care providers. The diagnosis can then be made using the patient's history and reconstruction of events that occurred before, during, and after the patient's excursion.

Treatments

Psychotherapy , sometimes involving hypnosis, is often effective in the treatment of dissociative fugue. Patients, with support from therapists, are encouraged to remember past events by learning to face and cope with the stressful experiences that precipitated the fugue. Since the cause of the fugue is usually a traumatic event, it is often necessary to treat disturbing feelings and emotions that emerge when the patient finally faces the trauma. The troubling events that drove a person to run and forget about his or her past may, when remembered, result in grief , depression, fear, anger, remorse, and other psychological states that require therapy.

Prognosis

The prognosis for dissociative fugue is often good. Not many cases last longer than a few months and many people make a quick recovery. In more serious cases, the patient may take longer to recover memories of the past.

Resources

BOOKS

Allen, Thomas E., Mayer C. Liebman, Lee Crandall Park, and William C. Wimmer. A Primer on Mental Disorders: A Guide for Educators, Families, and Students. Lantham, MD: Scarecrow Press, 2001.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association, 2000.

Beers, Mark H., and Robert Berkow, eds. "Dissociative Fugue." In The Merck Manual of Diagnosis and Therapy. 17th edition. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

ORGANIZATIONS

International Society for the Study of Dissociation. 60 Revere Dr., Suite 500, Northbrook, IL 60062. <http://www.issd.org/> .

National Alliance for the Mentally Ill. Colonial Place Three, 2107 Wilson Blvd., Suite 300, Arlington,VA 22021. <http://www.nami.org/index.html> .

Dean A. Haycock, Ph.D.